The banded sleeve gastrectomy revisited: long-term experience from a single centre.Featured
The ideal bariatric procedure provides permanence of weight loss with minimal patient morbidity. Sleeve gastrectomy now is an established procedure, applicable in many settings but its Achilles heel is weight regain. The placement of a band around the gastric sleeve has been suggested as a means to limit weight regain.
To review our long-term experience in a cohort of patients who had a laparoscopic banded sleeve gastrectomy using a silastic ring. Primary endpoint is amount of excess weight lost and secondary endpoints include re-intervention rate, comorbidity resolution and patient reported adverse effects.
A retrospective review of a bariatric database and a prospective questionnaire from a single centre was performed. Patient weights and clinical data were obtained via a standardized questionnaire after informed consent.
53 patient records were available for review, 10yr data was available for 28% of patients (n = 15). Mean pre-operative BMI was 37.3 kg/m2, mean BMI at 10yrs was 27.8kg/m2. Mean weight loss at 10yrs was 26.5kg (7.9kg – 43.5kg) while the mean percentage excess body weight lost at 10yrs was 86.99%. 20% of this cohort had complete resolution of comorbidities, 60% of patients reported mild, controlled, reflux symptoms and de novo reflux occurred in 40% (6/15). Almost all patients were on PPI at 10yrs. In terms of re-intervention, 5 patients required removal of silastic ring, 1 patient required conversion to gastric bypass for severe reflux and endoscopic intervention was needed in 9 patients (60%). Median patient satisfaction score was 9 (0-10).
Banded sleeve gastrectomy appears to have durable, long-term excess weight loss. The incidence of symptomatic reflux is high and of concern with subsequent high band removal rates. However, weight loss appears to be superior to non banded, conventional sleeve gastrectomy.